Leicester Real World Evidence Unit, Diabetes Research Center, University of Leicester, Leicester, UK.
National Institute for Health Research Leicester Biomedical Research Center, Leicester Diabetes Centre, Leicester, UK.
J Diabetes Investig. 2021 Jul;12(7):1175-1182. doi: 10.1111/jdi.13464. Epub 2020 Dec 15.
AIMS/INTRODUCTION: The aim of this study was to examine ethnicity-specific associations between type 2 diabetes mellitus and the risk of a cardiovascular disease (CVD) event as well as risk of specific CVD phenotypes in England.
We obtained data from the Clinical Practice Research Datalink for adults with and without type 2 diabetes mellitus diagnosed 2000-2006. The outcome was the first CVD event during 2007-2017 and the following components: aortic aneurysm, cerebrovascular accidents, heart failure, myocardial infarction, peripheral vascular disease and other CVD-related conditions. Flexible parametric survival models were used to estimate ethnicity-specific adjusted hazard ratios.
A total of 734,543 people with and without type 2 diabetes mellitus (29,847; 4.1%) were included; most were of white ethnicity (93.0% with and 92.3% without type 2 diabetes mellitus) followed by South Asian (3.2 and 4.6%). During a median follow-up period of 11.0 years, 67,218 events occurred (6,156 in individuals with type 2 diabetes mellitus). Type 2 diabetes mellitus was associated with a small increase in CVD events (adjusted hazard ratio 1.06, 95% confidence interval 1.02-1.09) in individuals of white ethnicity; whereas the adjusted hazard ratios were considerably higher in individuals of South Asian ethnicity (1.28, 95% confidence interval 1.09-1.51), primarily due to an increased risk of myocardial infarction (1.53, 95% confidence interval 1.08-2.18).
Despite universal access to healthcare, there are large disparities in CVD outcomes in people with and without type 2 diabetes mellitus. Other non-traditional risk factors might play a role in the higher CVD risk associated with type 2 diabetes mellitus in individuals of South Asian ethnicity.
目的/引言：本研究旨在探讨 2 型糖尿病与心血管疾病（CVD）事件风险以及英格兰特定 CVD 表型风险之间的种族特异性关联。
我们从 2000 年至 2006 年期间诊断出的患有和未患有 2 型糖尿病的成年人的临床实践研究数据链接中获取数据。结果是 2007 年至 2017 年期间的首次 CVD 事件以及以下组成部分：主动脉瘤、脑血管意外、心力衰竭、心肌梗死、外周血管疾病和其他与 CVD 相关的疾病。使用灵活参数生存模型来估计种族特异性调整后的危险比。
共有 734,543 名患有和未患有 2 型糖尿病的成年人（29,847；4.1%）被纳入研究；大多数人是白人种族（93.0%患有和 92.3%未患有 2 型糖尿病），其次是南亚人（3.2%和 4.6%）。在中位随访期 11.0 年期间，发生了 67,218 起事件（6,156 例发生在患有 2 型糖尿病的个体中）。2 型糖尿病与白人个体 CVD 事件的小幅度增加相关（调整后的危险比为 1.06，95%置信区间为 1.02-1.09）；而南亚人个体的调整后危险比则高得多（1.28，95%置信区间为 1.09-1.51），主要是由于心肌梗死风险增加（1.53，95%置信区间为 1.08-2.18）。
尽管普遍获得了医疗保健，但患有和未患有 2 型糖尿病的个体之间的 CVD 结局存在很大差异。其他非传统危险因素可能在南亚人个体中与 2 型糖尿病相关的更高 CVD 风险中发挥作用。
